ANNUAL GIVING
PAYROLL DEDUCTION FORM
Advancement Services
Shelbie King Hall, Room 316
824-2105
Please complete and return it to Advancement Services, Room 316
To support UAH and its programs, I wish to make my contribution as follows:
per pay period, No. of pay periods ____________ Total amount of gift
$ $
(There are 26 pay periods per year)
Pay period date to begin deductions:
Please check this box if you wish the deduction to be continuous until you inform the payroll department otherwise.
This contribution is to be used for:
President's Excellence Fund
Scholarship -
(Name of scholarship)
Other:
(Options for giving are shown at www.uah.edu/giving)
My spouse's employer will match this gift:
Spouse's Employer:
This gift is a joint gift with my spouse.
Spouse name
I hereby authorize the UAH Payroll Department to deduct my gift as specified above.
Print Name: UAH Department:
Address:
Street Address ZIPCity
Phone: E-Mail
Signature: Date:
Receipts issued annually for tax purposes.
